Patients came out losers when the Joint Commission that accredits hospitals, the hospital industry, and infection control physicians and nurses announced a policy on which they could agree. It's obvious why the American Hospital Association went along. Consensus was achieved by lowering the bar. The policy, announced in Washington D.C. on October 8, was billed as a huge step forward in patient safety. The truth is that it will do almost nothing to prevent infections that kill more than 100,000 patients a year.
Hospital workers' dirty hands are the number one cause of these infections. Doctors fail to clean their hands before treating patients more than half the time. Yet the consensus group did not recommend disciplining chronic offenders. No other industry treats safety rules as mere recommendations. Imagine airline pilots breaking rules half the time.
Inadequate cleaning in hospitals is another major cause of infections, because doctors' and nurses' hands become recontaminated as soon as they touch bacteria covered bedrails, privacy curtains and medical devices. There is solid research indicating how to clean hospital rooms to prevent MRSA (methicillin-resistant Staphylococcus aureus) infections, but the consensus group let hospitals off the hook with the following meaningless statement: clean "with approved disinfectants at appropriate dilutions for the appropriate amount of contact time." This vagueness will do nothing to correct the quick spray and wipe used in most patients' rooms.
A 2007 study of 20 hospitals from Washington D.C. to Boston found that over half the surfaces that are supposed to be disinfected before a patient is admitted to a room were left untouched by cleaners. When researchers at Rush Medical College trained cleaners to soak surfaces and wait ten minutes, as well as clean overlooked objects, the spread of bacteria to patients was reduced by two thirds. At Stamford Hospital in Connecticut, supervisors mark surfaces with an invisible substance detectable by a black light, and later check to make sure cleaners have disinfected these surfaces.
For a hospital to earn Joint Commission accreditation, rooms only have to look clean, not be clean. The consensus group did not recommend reversing that dangerous policy, even though infections are caused by invisible bacteria.
"MRSA is endemic in virtually all U.S. healthcare facilities," warns a June 2007 study. Yet the consensus group failed to call upon hospitals to screen incoming patients for the MRSA germ. A few patients unknowingly carry the germ on their body and shed it in tiny particles on virtually every surface. Screening is a noninvasive skin or nasal swab. Once MRSA positive patients are identified, hospitals can take precautions to prevent the germ from spreading to other patients.
Screening enabled several European countries to nearly eradicate MRSA infections. Numerous studies show that it works in the U.S. too, though less than a quarter of American hospitals screen. New Jersey and Pennsylvania require hospitals to screen all patients. The consensus group sets a lower standard, saying hospitals should screen only if MRSA infections exceed "institutional goals," a vague phrase meaning whatever number of infections a hospital is willing to accept.
Shockingly, the consensus group shies away from technologies that compensate for human error. To deliver medication to very ill patients, a tube called a catheter is inserted directly into a vein. The risk is that a lapse in sterile procedure, such as a doctor's dirty hands, will permit bacteria to invade the tube, causing a central line blood stream infection. These are fatal at least 12% of the time. Anti-microbial catheters have built-in germ killers. They are like airbags or anti-lock brakes, back up devices. The antimicrobial catheter costs $35 more than an untreated catheter, but it can stay in for many days. For about the same price per day as TV rental in a hospital, the high-tech catheter can reduce infection risk to near zero. It's a no brainer. But the consensus group recommends using it only after sterile procedures fail and infected patients exceed "institutional goals."
As timid as the consensus recommendations are, the Joint Commission promises only to study them and adopt some as conditions of accreditation beginning in 2010. Therefore, don't assume that accreditation means your hospital is clean or taking the steps needed to protect you from infection.
Clearly outside pressure is needed to force hospitals to clean up. On October 1, Medicare stopped reimbursing hospitals to treat many types of infections, including central line blood stream infections, and barred hospitals from billing patients for what Medicare won't pay. Hospitals will have to take a loss. Wisely, Medicare didn't leave it up to hospitals to decide how many infections are acceptable. Medicare calls them "never events," because even one can kill you.
The consensus group is correct about one thing. We have the scientific knowledge to prevent infections. What is lacking is the will. Sadly, the announcement last week won't change that.
Betsy McCaughey is Chairman of the Committee to Reduce Infection Deaths, adjunct senior fellow at the Hudson Institute, and a former Lt. Governor of New York State.